Tag: non-diet approach

Who is ED?

On By jodietitianIn UncategorizedLeave a comment

eating-disorder-mirror-drawingI first was introduced to ED back in 1996. I had just finished graduate school and took a part time job at an eating disorder program. As a dietitian, my main interest was in health promotion and disease prevention. It made sense to me that it seemed smarter and easier to help people prevent disease if possible through promoting a healthy lifestyle. It is much harder to treat illnesses that may have been prevented. I specifically remember a middle aged man who I met during my very first job as a dietitian in a small hospital. He was admitted after having a heart attack. His lifestyle was not healthy at all (smoking, unhealthy diet, no physical activity). I remember thinking that he should not have been there.

I left the hospital after just one year and changed my focus to helping people be healthy. I worked for WIC (Women, Infants and Children) and loved teaching young mothers about healthy eating. I also did some private practice and that is when I knew I needed more skills with counseling, and went back to graduate school (with a focus on counseling). It was while working on the college campus that I encountered students with “sub-clinical” eating disorders. In other words, they were restrained eaters who dieted yet had not developed an eating disorder yet. I did my research on “cognitive restraint” because I felt if we could stop people from dieting and focus on health instead, we could possibly prevent an eating disorder.

Although working with eating disorders was something I never planned to do, after doing my research, I ended up connecting with many eating disorder professionals and got my job at the eating disorder program. It was here where I was introduced to “ED”.

I got to observe group sessions and then got to run my own. Every patient is different however one of the common connections all of the patients related to was a “voice” that was constantly in their heads. Meet ED. I eventually imagined a little ugly creature sitting on my patient’s shoulders, feeding them thoughts and ideas, rules and insults, misinformation about themselves, food, their bodies, absolutely everything. This voice (ED) would follow them around all day long, into the night. It never stopped. It was a learning process for me as I learned about how this voice contributes to all of the distortions and beliefs individuals suffering from these eating disorders experience.

Here are some of the things my patients have told me ED says (warning, it will make you sad):

  • you can’t have that, it will make you fat
  • why did you eat that? you are worthless, you have no willpower!
  • don’t listen to her, she is lying, she wants you to gain weight
  • white flour is bad
  • meat is bad
  • you can’t eat fried food
  • you can’t have that, it has sugar in it
  • you need to burn that up, when are you going to do it? figure it out, you ate it, now you need to get rid of it
  • you look fine, they are just jealous because you lost weight. You need to lose more. Don’t listen to them
  • you are disgusting
  • you didn’t do enough. You need to do more, more laps, more sit-ups, more more more.

Get the picture? Depending on where someone is in the recovery process, talking about this voice does come up. It is a slow process, but helping individuals fight this voice is critical. Exposing ED for the liar that he is takes a lot of work and energy. Of course, every patient needs therapy to work through their specific issues that led to the eating disorder in the first place. As a dietitian, I focus on teaching the truth about foods, eating, weight, etc. Sometimes, during a visit with a patient who is fighting hard and finally aware of what a “healthy” voice is, ED still weasels his way back in. I admit to falling into the trap of arguing with ED, and then it hits me, and I stop. I have often said to patients “wait a minute, I am not going to engage ED, can I talk to YOU?!” Once I had a patient get up and dramatically rip ED from her shoulder and throw him in the waste basket! She said “I have lots of family celebrations this weekend and I want to enjoy them. ED is not invited!” I will never forget that strong visual.

Another thing people don’t often realize is that individuals with eating disorders are just that. Individuals who unfortunately struggle with this disease. They are not an “anorexic” or a “bulimic”. They are people. I have met the most extraordinary people who have had ED on their shoulders and have had to fight him daily. I have met lawyers, dancers, chefs, professors, soccer players, football players, mothers, aunts, fathers, sons, daughters. I have enjoyed getting to know these individuals and especially as ED fades away and they can be their very interesting, fun, loving, energetic and happy selves again. That to me has been rewarding beyond explanation.

And what about you? Unfortunately, I hear people mumbling out loud about food, their bodies, what they ate, exercise, etc. in ways that are not always healthy, and sound way too much like ED. He is a villain that somehow has become culturally acceptable (which makes it real hard for those struggling). Remember, prevention is a lot easier than recovery. When you hear a berating, negative voice in your head about anything to do with eating or your body, just try to be aware. Stop ED in his tracks. Say “you are full of it!” If you can’t stop that voice, you may want to consider getting some help. Maybe someday, our culture will normalize it’s view of eating and body size and he will fade away. Until then, I hope you continue to fight the craziness in your own way.

When Exercise Isn’t Fun Anymore

On By jodietitianIn body image, Uncategorized3 Comments

kids on monkey bars Remember back in the day when you had recess in elementary school? It was always the highlight of the day, the time where you could run free outside, swing on the swings, play tag, or climb the monkey bars. Then after school, if you were lucky, you were allowed to play kickball outside with your friends until it got dark. Before you ever thought about being active or needing to exercise to be healthy, you were already doing it. But you were having fun!!

Things have changed. It seems to me there are few adults that I know who do fun active things because, well, they are just FUN. Most adults, especially those with body image or weight concerns appear to be “forcing” themselves to “exercise” with the intention of losing weight and/or changing their body. Not to be stronger, feel better or have more energy. This typically organized movement (aka exercise) sometimes involves a gym, a treadmill, a video or some other activity that the person does not look forward to (not like the monkey bars back in the day). Yes, there are many people who actually really love to going to the gym and actually have a blast doing their Zumba class. These are not the people I am referring to.

In her book “Body Wars: Making Peace with Women’s Bodies”, Dr. Margo Maine explains that particularly if you exercise excessively it could be a symptom of an underlying psychological condition. If you are not able to solve the issue yourself you may need the support of a therapist. She describes the following behaviors that may indicate a problem:

  • you judge a day as “good” or “bad” based on how much you exercised
  • you base your self-worth on how much you exercise
  • you never take a break from exercise no matter how you feel or how inconvenient it is
  • you exercise even though you are injured
  • you arrange work or social obligations around exercise
  • you cancel family or social engagements to exercise
  • you become angry, anxious or agitated when something interferes with your exercise
  • you sometimes wish you could stop but are unable to
  • you know others are worried about how much you exercise but don’t listen to them
  • you always have to do more (laps, miles, weights) and rarely feel satisfied with what you have done
  • you count how many calories you burn while exercising
  • you exercise to compensate from overeating

So, if any of these description ring true for you, just being aware is the first step. For more information on Dr. Maine’s book which includes many great resources for those struggling with body image concerns, check out this link:Body Wars

And remember, it is never too late to start going to the playground again!!!

Regarding “Clean” Eating….

On By jodietitianIn clean eating, dieting, weight1 Comment

mopThis women’s face is how I feel several times per week. Have you fallen for the latest weight loss craze? This is driving me crazy!! It angers me when people are taken advantage of because they are desperate to lose weight. How do you define “clean eating”??? And why does it usually involve some type of juice that you need to purchase?? Anyway, try to find some good long term outcome studies on this diet approach, and please share them with me. I can’t find any. The bottom line is any trick to make you eat A LOT less will make the force of gravity on your body less over time (that means you will weigh less). It won’t last. Most of these diets have you do a juice fast or just fruits and vegetables or maybe a “clean” shake for a certain amount of time. You will lose weight as your body breaks down muscle (sorry but the Krebb Cycle prefers amino acids to keep producing it’s ATP’s for energy, not the fat you are hoping it would use). Not to mention the typical dehydration that occurs when your body is breaking down muscle from starvation (because when you break down muscle you need to get rid of the nitrogen through your kidneys, and your body knows to use water to dilute it otherwise your kidneys would be damaged…unfortunately, that happens to some people anyway). And if you are getting way too little calories, your body may be building up toxins in your blood called ketones….that isn’t too “clean” if you ask me.

Not to mention, don’t you have to eventually eat something? Then what? Have you learned anything about yourself? Have you identified some unhealthy habits you may have had and are you magically now able to change them? Probably not. If I could have a dollar for everyone I knew who lost weight on a plan like this, but then gained it back, I might have retired by now. This latest fad is nothing new, just like the low carbohydrate diets, the low fat diets, the high protein diets, and on and on, it just delays the inevitable work your really need to do.

I’m good with vegetables and fruits in your diet. But this is way too much thinking and that is something we know people can’t sustain over time. Why not simply work on adding in these healthy foods to your diet and continue working on listening to your hunger and fullness, recognizing when you are eating when you are not really hungry, taking time to move your body because it is fun and feels good and also contributes to your health? Stop all the “cognitive restraint” and focus on health. There  is no such thing as clean eating.